AACOM monitors and advocates on federal issues that address or may impact osteopathic medical education. See content below to learn about health reform issues, related AACOM activity and additional resources.

Updated: 5/1/2012

Supreme Court Hears Case Challenging Affordable Care Act On 03/26/12 – 03/28/12, the Supreme Court of the United States heard oral arguments on the challenges brought forth by the Attorneys General of 26 states and by the National Federation of Independent Businesses on the constitutionality of the Patient Protection and Affordable Care Act (PL 111-148). The issues at hand:

If the individual responsibility provision is unconstitutional, what other parts of the law, if any, must also be struck down (referred to as “severability”)?

Is the Affordable Care Act’s (ACA) expansion of Medicaid constitutional?

The Court’s final ruling is expected prior to adjourning its current session, which is scheduled for 06/30/12.

Two House Committees Approve IPAB Repeal LegislationOn 3/8/12, the House Ways and Means Committee approved legislation, H.R. 452, the Medicare Decisions Accountability Act of 2011, introduced by Rep. David Roe (R-TN), to repeal the Independent Payment Advisory Board (IPAB) in the Affordable Care Act (ACA). The action follows approval of the bill by the House Energy and Commerce Committee on March 6. The bill could come to the House floor shortly after the House returns from a weeklong recess that begins March 12. IPAB, created under the ACA, is to begin operating in 2014. The board's 15 members - appointed by the president and subject to Senate confirmation - are charged with setting program reimbursement policy that would become law unless Congress intervenes.

Supreme Court Announces Dates for Challenges to Health Care Reform Law
On 12/19/11, the U.S. Supreme Court announced that it will hear oral arguments on challenges to various components of the Patient Protection and Affordable Care Act (ACA) on 03/26/12 – 03/28/12. The Court is expected to announce its ruling by late June. For additional details, visit http://www.supremecourt.gov/docket/PPAACA.aspx.

Supreme Court to Hear Case Challenging Affordable Care Act
On 11/14/11, the U.S. Supreme Court announced that it will hear oral arguments on a decision from the U.S. Court of Appeals for the 11th Circuit that struck down a key provision of the Patient Protection and Affordable Care Act (ACA), ruling that the federal government cannot require individuals to purchase health insurance by 2014. On 09/27/11, the Obama Administration filed a petition requesting review of the case. The date for the argument has not been scheduled; the Supreme Court is expected to take up the case no earlier than March and to issue a decision around June. Two hours of oral arguments will be set aside to determine the legality of the ACA’s individual mandate, and a third hour will be allotted for the court to consider whether the lawsuit challenging the mandate is barred by the tax anti-injunction act.

11th Circuit Appeals Court Rules Health Reform Mandate Unconstitutional On 8/12/11, in a 2-1 decision, the United States Court of Appeals for the 11th Circuit struck down a key provision of the Affordable Care Act and ruled that the federal government cannot make individuals purchase health insurance. The court held that Congress exceeded its powers under the U.S. Constitution's commerce clause when it enacted the Affordable Care Act’s individual mandate, a provision scheduled to take effect in 2014 that would require most Americans to buy health insurance or pay a penalty.

An excerpt of the court’s opinion states, “What Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die”. The law is expected to go before the Supreme Court for review, as the 11th Circuit Court’s ruling conflicts with the Court of Appeals for the 6th Circuit in Cincinnati, OH, which ruled that the coverage mandate was constitutional. The Supreme Court could review the law as early as October 2011.

AACOM Sends Letter to House Opposing HR 1216 AACOM sent a letter to House Members in opposition to H.R. 1216. On May 25, 2011, the U.S. House of Representatives passed H.R. 1216, a bill to convert the mandatory appropriations for the Teaching Health Center (THC) program established by Section 5508 of the Patient Protection and Affordable Care Act (ACA) into an authorization subject to the annual appropriations process. The Affordable Care Act appropriated $230 million for five years to the THC program to operate graduate medical education programs in community-based settings. The bill now heads to the Senate, where it is expected to fail. AACOM continues to work with Congress to highlight the value of THCs to the U.S. health care system, and the potential contribution osteopathic medical education can make in this type of training venue.

President Obama Signs 1099 Repeal Bill On 4/15/11, President Obama signed into law legislation to repeal the 1099 reporting requirements for small businesses of payments of $600 or more to corporations. The U.S. Senate voted 87-12 to approve the legislation, H.R. 4, on 4/5/11. Before passage, the Senate rejected an amendment, by a vote of 41-58, offered by Senator Robert Menendez (D-NJ) that would have directed the Department of Health and Human Services to study whether the offset used to pay for the 1099 repeal would increase either insurance premiums in the exchanges or the number of uninsured individuals. Last month, the House of Representatives voted 314-112 to pass the legislation, with 76 Democrats approving the bill.

HHS Announces Partnership for Patients On 4/12/11, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, MPA, and Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick, MD, MPP, announced a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to keep patients from getting injured or sicker and to help patients heal without complication. According to HHS, the combined efforts of the partnership could save 60,000 American lives and reduce millions of preventable injuries and complications in patient care over the next three years. It could also save as much as $35 billion to the health care system, including up to $10 billion in Medicare savings. The CMS Innovation Center will dedicate up to $500 million to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. The Innovation Center will help hospitals adopt effective, evidence-based care improvements to target preventable patient injuries on a local level, developing innovative approaches to spreading and sharing strategies among public and private partners in all States. For more information, visit www.HealthCare.gov/news/factsheets/partnership04122011a.html.

Congress Passes 1099 Repeal Bill; Heads to the President On 4/5/11, the Senate voted 87-12 to approve legislation, H.R. 4, to repeal the 1099 reporting requirements for small businesses of payments of $600 or more to corporations. Before passage, the Senate rejected an amendment, by a vote of 41-58, offered by Senator Robert Menendez (D-NJ) that would have directed the Department of Health and Human Services to study whether the offset used to pay for the 1099 repeal would increase either insurance premiums in the exchanges or the number of uninsured individuals. Last month, the House of Representatives voted 314-112 to pass the legislation, with 76 Democrats approving the bill. The legislation now heads to President Obama for his signature.

House Energy and Commerce Committee Approves Legislation to Repeal Mandatory ACA FundingOn 4/5/11, the U.S. House of Representatives’ Energy and Commerce Committee approved, along party lines, legislation to convert mandatory funding in certain provisions of the Affordable Care Act (ACA) to discretionary funding. Five bills in total were approved, including H.R. 1216, which would convert funding for graduate medical education at teaching health centers from direct funding to an authorization of appropriations, and H.R. 1217, which would repeal the Prevention and Public Health Fund. Democratic amendments were introduced for each of the five bills but did not pass. AACOM submitted, on 4/4/11, a letter to the House Energy and Commerce Committee in opposition to H.R. 1216.

House Passes 1099 Repeal, Setting Up Debate with Senate On 3/3/11, the U.S. House of Representatives approved the “Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011”, H.R.4, by a vote of 314-112, repealing provisions of the Affordable Care Act that required all businesses to submit 1099 tax reporting forms for all services and goods greater than $600 in a year. In February, the U.S. Senate passed its own repeal of the 1099 mandate attached as an amendment to the Federal Aviation Administration reauthorization bill, but the House did not take up the Senate’s legislation. The House and Senate will now need to reconcile the two versions and how to pay for the measure.

Senate Rejects Repeal of Health Care Overhaul, Senate Strikes Tax Provision On 2/2/11, the U.S. Senate rejected, by a vote of 47-51, a motion to waive a budgetary point of order against an amendment offered by Senate Minority Leader Mitch McConnell (R-KY), which would have repealed the health care law. All Republicans voted for the repeal, while no Democrats supported it. In addition, the Senate supported the removal of a tax reporting requirement from the 2010 health care overhaul. Approved by unanimous consent, by a vote of 81-17, the amendment, offered by Senator Debbie Stabenow (D-MI), would repeal a provision in the health care law requiring businesses to submit a 1099 form to the IRS for each vendor to whom they pay more than $600 each year for goods. The bill now moves to the House.

Obama Renominates Berwick as CMS AdministratorOn 1/26/11, President Obama renominated Donald M. Berwick, MD, as Administrator of the Centers for Medicare & Medicaid Services (CMS). Dr. Berwick was appointed Acting CMS Administrator by President Obama, bypassing the Senate confirmation process, in July. Dr. Berwick may maintain his position as acting administrator only through the end of 2011. He must be confirmed by the Senate to become permanent administrator.

House Passes Health Reform RepealOn 1/19/11, the U.S. House of Representatives approved legislation to repeal the Affordable Care Act. The final vote was 245-189 with 3 Democrats voting with the Republicans in favor of repeal. The U.S. Senate has no plans to consider this bill at this time. In addition, the House will vote on a measure to instruct four committees to draft alternative health care proposals that reflect Republican priorities.

CMS Administrator Testifies Before Senate Finance CommitteeOn 11/17/10, Centers for Medicare and Medicaid Services (CMS) Administrator Donald M. Berwick, MD, testified before the Senate Finance Committee at a hearing titled “Medicare and Medicaid: Taking Steps to Modernize America’s Health Care System.” This is thefirst time Dr. Berwick has testified before Congress since President Obama appointed him as CMS administrator with a July 7 recess appointment. Dr. Berwick answered questions concerning the Affordable Care Act’s (ACA) implementation of the Medicare and Medicaid programs. He also warned the Finance Committee about the negative repercussions of repealing the ACA. Dr. Berwick stated that CMS will work toward providing better care at a low cost both for individuals and the country. He proposed to meet those goals by: reducing medical errors, controlling the cost of health care, introducing innovative technologies, improving interagency cooperative efforts, utilizing the newest technology to combat fraud, and emphasizing the value of preventive medicine. As a recess appointee, Dr. Berwick can serve without confirmation through the end of 2011. To view the Senate Committee hearing and Dr. Berwick’s testimony, please visit: http://finance.senate.gov/hearings/hearing/?id=280ebc81-5056-a032-5254-1010c1e9b945.

On 03/23/10, President Obama signed into law the Patient Protection and Affordable Care Act (PL 111-148), an historic act expected to cover 32 million uninsured Americans at a cost of $940 billion while reducing the deficit by $143 billion over that same time frame. One week later, on March 30, 2010, the President signed into law a package of negotiated changes to the new health reform law – the Health Care and Education Reconciliation Act of 2010 (PL 111-152). Please click hereto view a summary of the health reform provisions that are of interest to osteopathic medical education. For a description of the changes authorized by the law to the Primary Care Loan Program, please see a Federal Registernotice issued by the Health Resources and Services Administration.

On 03/18/10, the House Rules Committee posted several budget reconciliation documents that contain health care and student financial aid overhaul provisions. These documents include the Health Care and Education Affordability Reconciliation Act of 2010, an amendment in the nature of a substitute that contains negotiated changes to the Senate-passed health reform bill, and a section-by-section analysis.

On 02/25/10, President Obama and a bipartisan group of federal Representatives and Senators as well as administration officials attended the White House health care summit to discuss and seek consensus on the scope, cost, and effectiveness of the stalled health reform efforts. The President was attempting to reach out to Republicans while highlighting his party’s priorities on health reform. President Obama emphasized Republican proposals that he supported in the summit — market-based exchange; tort reform; and a focus on cutting waste, fraud, and abuse in Medicare. Although the President’s essential message to congressional leaders was to find common ground, he stressed the significance of moving forward in the next four to six weeks to pass health reform legislation.

Throughout most of the month of January, House and Senate leaders considered various procedural scenarios under which the health reform bill could be enacted. Progress towards enactment stalled following the special election in Massachusetts, which altered the filibuster-proof advantage of the Senate majority party. On 12/24/09, the Senate approved their version of the health reform bill, by a vote of 60-39, and on 11/07/09, the House approved their version of the health reform bill by a vote of 220-215. If enacted, the Senate and House bills contain provisions that would expand health insurance coverage; provide a permanent fix to the sustainable growth rate formula that sets Medicare physician payment rates; provide a bonus payment to primary care physicians; and reauthorize Title VII programs. There is no provision in either bill to increase the number of Medicare-funded GME slots.

The House Ways and Means, Energy and Commerce and Education and Labor Committees released a tri-committee health reform bill, America's Affordable Health Choices Act. In this legislation, the Committees expand health insurance coverage, provide a permanent fix to the sustainable growth rate formula that sets Medicare physician payment rates, provide a bonus payment to primary care physicians, reform the GME program, and reauthorize Title VII. A summary of the bill can be found at: http://www.aacom.org/advocacy/topics/Documents/062609-Housebillsummary.pdf. Before adjourning for the August recess, all three committees completed markups of the legislation; House leadership and the Rules Committee will be responsible for melding all three versions and reconciling their differences.

AACOM is collaborating with other organizations to support the inclusion of a provision to provide GME funding for teaching health centers (THCs). This provision was included in the revised Senate Finance Committee Chairman's mark. This legislation also includes a grant program to provide start-up funding for THCs. A joint AACOM-AOA letter, dated 07/23/2009, in support of this program can be found here: http://www.aacom.org/advocacy/topics/testimony/Documents/072309-SenateFinCmte.pdf.

The Senate leadership is in the process of combining the Senate Finance and Health, Education, Labor, and Pension (HELP) Committees health reform bills, which have some very significant differences. Most notably, the HELP bill includes a public insurance option, while the Finance bill provides only for co-ops. The combined bill is expected to go to the Senate floor in mid-to-late October. Once the Senate completes its work, the House will send its bill to the floor.

The Senate Finance Committee with jurisdiction over Medicare marked up and passed by a 14-9 margin the America’s Healthy Future Act of 2009. Senator Olympia Snowe (R-ME) was the only Republican to cross party lines and vote for the legislation. The legislation received a Congressional Budget Office score of $829 billion over 10 years and would expand health insurance coverage to 94 percent of eligible Americans. The legislation includes a 10 percent bonus over five years for primary care services and would redistribute unused graduate medical education slots for primary care training use. The legislation, however, provides only a one-year patch for the sustainable growth rate, replacing a 21 percent cut with a 0.5 percent update in 2010. A full summary of the legislation can be found at: http://www.aacom.org/advocacy/topics/Documents/HealthyFutureAct2009.pdf .

The Senate HELP Committee legislation also contains the Medical Economic Deferment for Students Act, which was included in an amendment by Senator Richard Burr (R-NC). This provision would retain the current debt-to-income ratio for borrowers to qualify for economic hardship deferment.

The Senate HELP Committee released and marked up the Affordable Health Choices Act. Included in this legislation are provisions to expand access to health insurance coverage, to create prevention and wellness programs, and to strengthen the health professions workforce. The Title VII programs are reauthorized and an assessment program is created. A summary of the bill is available at: http://www.aacom.org/advocacy/topics/Documents/061709-HELPsummary.pdf.

President Obama sent a letter on 06/02/09, to Senators Ted Kennedy and Max Baucus, chairman of the HELP and Finance Committees, respectively, on the importance of reforming the health care system this year. The President would like to sign a reform bill into law this October.